Last reviewed December 2012
- Helping teenagers, thirteen to eighteen years, adjust
- What words should I use?
- What teenagers, thirteen to eighteen years, understand about death
- Support services, resources and information
Children’s understanding of illness and the implications of bad news varies depending on their age and family experiences. The information below gives an overview of the needs of teenagers, thirteen to eighteen years, which can be helpful when working out what to say to them and how you might respond to lessen the impact of the news on them. Professional help may benefit a child who does not seem to be coping.
|Understanding of disease||Possible reactions||Suggested approaches|
• They are capable of abstract thinking: they can think about things they have not experienced themselves.
• They are starting to think more like adults and may want lots of information about the diagnosis.
• They are able to understand that people are fragile.
• They are able to understand complex relationships between events.
• They are able to understand cause and effect, that is, relating to symptoms and illness or between action and outcome.
• They are more likely to deny fear and worry to avoid discussion. They may talk to friends about what is happening, and act as though their friends are more important than their family.
• Want to be more independent and treated like an adult.
• Anger and rebellion.
• Critical of how adults react to or handle the situation.
• Depression or anxiety.
• Worry about being different.
• Poor judgment and risk-taking behaviour (e.g. binge drinking, smoking, staying out late, unsafe sex).
• Physical symptoms from stress (e.g. stomach-aches, headaches).
• More likely to turn feelings inward (so adults are less likely to see reactions).
• Regression: some lapse into previous behaviours, such as watching children’s TV shows or being very insecure and dependent on parents.
• Worry that they will also get the cancer, particularly if they’re a daughter of a woman with breast cancer.
• Encourage them to talk about their feelings, but realise they may find it easier to confide in friends, teachers or other trusted people.
• Provide plenty of physical and verbal expressions of love.
• Talk about role changes in the family.
• Provide privacy as needed.
• Encourage them to maintain activities and friendships. Talk about finding a balance between going out and staying at home.
• Set appropriate limits.
• If there are problems, provide opportunities for counselling.
• Don’t rely on them to take on too many extra responsibilities.
• Provide resources for learning more about cancer and getting support.
• Make agreements that you don’t always want to talk about cancer – you still want to talk about homework, sport, friends, boyfriends/girlfriends, their part-time job, etc.
• See also ideas for children, 6–12 years.
It’s often hard to find the right words to start or continue a conversation. These ideas may help you work out what you want to say. Although grouped by age, you may find that suggestions in a younger or older age bracket are more suitable. See here for tips on how to answer specific questions.
Younger school-age children, 6–9 years
Young children can understand basic explanations about many things, including illness and family routines. They need reassurance to correct misunderstandings so they continue to feel loved, safe and cared for.
“I have an illness called cancer. It means some lumps are growing inside my body that shouldn’t be there, and they’re making me sick. I am going to have an operation in hospital to have the lumps taken out. Then I’ll have some more medicine to make sure they don’t grow back.”
“The doctors say that Dad has a problem with his blood. That’s why he’s been very tired lately. The illness is called… Dad’s going to have treatment to make him well again.”
“Lots of people get cancer. We don’t know why it happens. Most people get better and we expect I will get better too.”
To address misunderstandings:
“We can still have lots of kisses and cuddles – you cannot catch cancer from me or from anyone.”
“Cancer is a disease of the body that can be in different places for different people.”
“Even though your school friends say that cancer is really bad and I will get very sick, they don’t know everything about this cancer. I will tell you what I know about my cancer.”
To explain changes and reassure them:
“The doctors will take good care of me. I will have treatment soon, which I’ll tell you about when it starts.”
“Even though things might change a bit at home, you’ll still be able to go to tennis lessons while Dad is having treatment.”
“Mum is going to be busy helping Grandma after she comes out of hospital. There’s ways we can all help out, but mostly things won’t change for you.”
“You don’t have to tell your friends about me having cancer if you don’t want to, but I would like to let your teachers know so they understand what’s happening at home.”
Older school-age children and teenagers, ten to eighteen years
In upper primary and high school, children have a more complex understanding of illness and issues affecting them and their families. Teenagers are starting to think more like adults. Explanations about the cancer can be more detailed. Children of this age not only need reassurance about their own well-being, but also about the person with cancer.
“We’ve had some bad news. I’ve got cancer. We don’t know what we’re dealing with yet, but I’m going to have surgery so that the doctors can have a look and find out.”
“You know that Mum has been sick a lot lately. The doctors told us today that the tests show she has cancer. The good news is that she has an excellent chance of beating it.”
To address misunderstandings:
“There are lots of different types of cancer and they’re all treated differently. Even though Uncle Bob had cancer, it might not be the same for me.”
“The doctor doesn’t know why I got cancer. It doesn’t mean that you’ll get cancer too. It’s not contagious (you can’t catch it) and the cancer I have is not genetic (it doesn’t run in families).”
“Even though Grandma has cancer, the doctors say she’ll probably be okay because she was diagnosed early.”
To explain changes and reassure them:
“Things will be different at home when Dad’s having treatment but we’ll be able to visit him at the hospital often.”
“After my operation, there’s a few things I won’t be able to do for a while, like lifting things and driving. So you’ll all have to pitch in at home, and Dad will leave work early to take you to your after-school activities.”
“Whatever happens, you will always be cared for and loved. We will tell you what’s going on as soon as we are told.”
“If you think of any questions or have any worries, you can come and talk to me. It’s okay if you want to talk to someone else too.”
In preparing children for the loss of a parent or other loved one, it can help if you understand how death is perceived at different ages.
|Understanding of death||Possible reactions||Suggested approached|
• Understand death as much as an adult, but may not have the emotional capacity to deal with its impact.
• Research suggests that teenagers need preparation for a parent’s death as much as possible. They’re often more distressed when their parent is ill than after the death.
• May deny their feelings or hide them in order to protect you.
• May not look to others for support thinking they can handle it alone.• May distance themselves from their family and talk to their friends instead.
• Struggle with not being able to do their normal social activities.• Worry that death is frightening or painful.
• Encourage them to talk about their feelings to friends or another trusted adult.
• Negotiate role changes in the family.
|Organisations that can help||Contact details||Information|
|Cancer Council||13 11 20||Cancer Council offers a range of information and services to help people with cancer, their families and friends, including telephone support groups, Cancer Connect and the online forum www.cancerconnections.com.au.|
|CanTeen||The national support organisation for young people aged 12 to 24 living with cancer, children of people with cancer and siblings of people with cancer.|
1800 55 1800
|Kids Helpline is a telephone, web and email counselling service with a fun, interactive website for kids, teens and young adults. It offers confidential counselling for anything worrying a child.|
|Lifeline||A general telephone counselling service.|
|youthbeyondblue||Supports young people dealing with depression, anxiety and other mental health problems. They provide tips on how to talk about depression and get help.|
|Australian Centre for Grief and Bereavement||This organisation provides information and support for people caring for children and adolescents who have been impacted by trauma and loss.|
|Young Carers (Carers Australia)||This organisation supports young people who are caring for a parent who is physically or mentally ill. They run support programs and provide information.|
|Websites for teenagers, age 12–18 years||Contact details||Information|
|CanTeen||This is CanTeen’s website for teenagers and young adults who have cancer in their lives. There are lots of real-life stories, blogs and forums and information. You can also download all the Now What...? books.|
|Kids Konnected||www.kidskonnected.org||A US website for children with a parent with cancer or who have lost a parent to cancer.|
|My Parents Cancer||www.myparentscancer.com.au||A Cancer Australia website for young people aged 13 to 19 whose mum has breast cancer, although lots of the information is relevant for any cancer. It has personal stories of other young people and offers reliable, practical suggestions.|
|Reachout||www.reachout.com.au||A site for young people going through difficult times and experiencing challenges on a wide range of issues. Covers general mental health and well-being.|
|Rip Rap||www.riprap.org.uk||A UK site for 12 to 16 year olds who have a parent with cancer. It includes information about cancer and its treatment, and individual stories of how cancer has affected other kids.|
Books for younger readers
She’s Got What? A story about cancer
by Carrie Lethborg and
Angela Kirsner, St Vincent’s Hospital Melbourne, 1999
When Someone You Love Has Cancer: a guide to help kids cope (Written from a Christian perspective), Alaric Lewis Abbey Press, 2005
Beginnings and Endings with Lifetimes in Between by Bryan Mellonie and Robert Ingpen, Penguin, 2005
I Miss You: a first look at death, Pat Thomas Barron’s Educational Series, 2001
Because... Someone I Love Has Cancer (Activity book for kids aged 5–10), American Cancer Society, 2002
What About Me? (Comic book for children aged eight to 14 who have a parent with cancer), Cancer Council SA, reprinted 2011
Books for teenagers
Allie McGregor’s True Colours by Sue Lawson,
Black Dog Books, 2006
Now What...? Dealing with your parent’s cancer, CanTeen, 2010
Now What...? When your parent’s cancer can’t be cured, CanTeen, 2011
Now What...? Living with the death of your parent or brother or sister from cancer, Canteen, 2010
When Your Parent has Cancer: a guide for teens, National Cancer Institute, 2005
Information reviewed by: A/Prof Jane Turner, Department of Psychiatry, The University of Queensland; Frankie Durack, Counsellor and Play Therapist, WA; Carol Hargreaves, Cancer Council Helpline Consultant, Cancer Council NSW; Dr Carrie Lethborg, Clinical Leader, Cancer Social Work, Coordinator, Psychosocial Cancer Care, St Vincent’s Hospital, VIC; Angelita Martini, Consumer and Karin Steinhoff, Consumer.